摘要
目的:探讨腹腔镜辅助胃癌根治手术对进展期胃癌患者近期及远期疗效的影响.方法:选取2007-06/2009-06首都医科大学平谷区医院普外科收治的212例行D2根治手术的进展期胃癌患者为研究对象,其中110例行常规开腹手术治疗(开腹组),102例行腹腔镜辅助胃癌根治手术治疗(腹腔镜组).比较两组患者术中、术后恢复、并发症发生率及5年总生存率(overall survival,OS)、无瘤生存(disease-free survival,DFS)、无局部区域复发生存(locoregional recurrence-free survival,LRFS)、无远处转移生存(distant metastasisfree survival,DMFS),并对术后并发症发生的危险因素进行分析.结果:腹腔镜术中出血量少于开腹组,术后进食流质时间、排气时间、住院时间短于开腹组(P<0.05),两组淋巴结清扫数目、手术时间差异无统计学意义(P>0.05).腹腔镜组术后并发症发生率为17.65%低于开腹组30.91%,差异有统计学意义(P<0.05).经Cox风险模型风险可知,手术时间、术前合并症、是否行腹腔镜手术是胃癌根治术后并发症发生的独立危险因素.术前合并症及手术时间是腹腔镜辅助胃癌根治手术的独立危险因素.腹腔镜组5年OS、DFS、LRFS、DMFS与开腹手术相比差异无统计学意义(P>0.05).结论:腹腔镜治疗进展期胃癌可获得与开腹手术相同的治疗效果,且具有显著的微创优势.术前合并症及手术时间是影响腹腔镜治疗进展期胃癌术后并发症的独立危险因素.
AIM： To investigate the short-term and longterm efficacy of laparoscopic-assisted surgery in patients with gastric cancer.METHODS： Two hundred and twelve patients who underwent routine D2 radical surgery at Pinggu Hospital from June 2007 to June 2009 were selected, including 110 receiving conventional open surgery（laparotomy group） and 102 receiving laparoscopic assisted surgery（laparoscopic group）. Postoperative recovery was compared between the two groups. The complication rate, 5-year overall survival（OS）, disease-free survival（DFS）, locoregional recurrence- free survival（ LRFS）, distant metastasis-free survival（DMFS）, risk factors and postoperative complications were analyzed.RESULTS： The blood loss was significantly less in the laparoscopic group（P〈 0.05）. The times to liquid food ingestion and anal exhaust and hospital stay were significantly shorter in the laparoscopic group（P〉 0.05）. The number of lymph nodes harvested and operative time showed no significant difference between the two groups（P〈 0.05）. The rate of postoperative complications was significantly lower in the laparoscopic group（17.65%） than in the laparotomy group（30.91%）（P〈 0.05）. Operative time, preoperative comorbidities, and laparoscopic assisted surgery were identified as independent risk factors for the occurrence of postoperative complications. Preoperative comorbidities and operative time were independent risk factors for laparoscopic assisted surgery. The 5-year OS, DFS, LRFS, and DMFS showed no significant differences between the two groups（P〉 0.05）. CONCLUSION： Laparoscopic assisted surgery in management of advanced gastric cancer has similar therapeutic effects to open surgery, but is minimally invasive. Preoperative comorbidities and operative time are independent risk factors for the development of postoperative complications in laparoscopic treatment of advanced gastric cancer.
出处
《世界华人消化杂志》
CAS
2015年第3期432-437,共6页
World Chinese Journal of Digestology
关键词
进展期胃癌
腹腔镜
根治手术
并发症
Advanced gastric cancer
Laparoscopy
Radical surgery
Complications
